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From good intentions to Equitable Solutions in Health Research Collaborations – The Research Fairness Initiative (RFI)

By Kirsty Kaiser
on August 23, 2018

Global research, large scale innovation and socio-economic development have become a product of collaborations, partnerships and networks. This applies not just to collaborations between individual scientists but also and especially to institutions, organisations and industry. Without effective collaboration, science is stifled, and impact on health, equity and development will be hard to achieve, if at all.

The economies of the ‘global south’ are not sufficiently strong to develop and sustain research systems capable of solving the major problems facing them – think Ebola Virus Disease, HIV/AIDS, and Zika Virus, for example. Enter funding and expertise from the ‘global north’ which usually provides the resources and expertise required to conduct clinical trials.  While Africa is clearly the beneficiary of this global solidarity when a new vaccine, drug or technology becomes available, the increased social and economic capital resulting from research and innovation tends to remain in the ‘global north’.

For this reason, it is time to substantially change the global health research narrative. The Sustainable Development Goals (SDGs) identified ‘partnerships’ as crucial to achieving the SDGs and created even a separate Goal for this – SDG17. It does not, however, provide a metric for “good” or “fair” partnerships, nor does it place collaboration in the context of ensuring increasing leadership by low income countries themselves – in all spheres, including global health research.

The academic literature on this topic does not provide much relief either. In general, similar problems are restated (think ‘authorship’ and ‘overhead costs’) and new problems are described (think ‘data ownership’, ‘intellectual property rights’ or ‘promoting the role of women scientists’). Suggestions for change are made, but no globally accepted frameworks for research partnership conduct have resulted so far.

True – some institutions have formulated excellent guidelines for responsible practice in transboundary research (e.g. the KFPE’s 11 Principles and 7 questions and the CCGHR’s Principles for Global Health Research, and CCGHR’s Partnership Assessment Toolkit) but these are non-enforceable and not widely known or used even within institutions and countries that developed them.

While research ethics review does, by and large, not involve itself with the partnership aspect of research, the more recent interest in ‘research integrity’ does, particularly through its second foundational document, the Montreal Statement that focuses explicitly on the quality of institutional collaborations in the pursuit of research integrity. This statement is also aspirational rather than pragmatic and does not provide a framework for implementing nor for assessing equitable research collaborations.

In the absence of agreed frameworks, research collaborations tend to be designed for scientific validity more than to improve low income country research systems through partnerships. Any constructive impact on research system capabilities seems ‘ad hoc’ instead of being explicit, consistent, systematic, and measurable.

The Research Fairness Initiative was created through wide consultation as a pragmatic instrument to deal with this lacuna in global health research.  The RFI was born out of one of the Council on Health Research for Development (COHRED) ’s other projects – Fair Research Contracting – after it was realised that there was a major gap when it came to dealing with issues of fairness in research partnerships – not only in terms of issues such as Intellectual Property Rights or Technology Transfer but also in other areas which produce benefits, such as local staffing or empowering women in science. What was initially called the “COHRED Fairness Index” or CFI, took two years to develop – first through a Technical Working Group and then, in 2015, a Colloquium which involved stakeholders from various different sectors in health research. Following this there was a shift in thinking, and the idea changed from an index to a reporting initiative – emphasizing transparency and improvement rather than a focus on norms and cut-off points. The Research Fairness Initiative was born, and since then has been developed over time with the RFI guides and workshops in several countries.

The concept is simple – an institution reports its current policies and practice in relation to 15 key topics – dealing with fairness of opportunity (everything that happens before research begins), fair process (everything that happens during the research process) and fair sharing of benefits, costs and outcomes (everything that happens after research has been concluded) – and states how it intends to improve over the next two years. When uptake of the RFI becomes the norm, it will finally be possible to begin systematic learning on a topic that is crucial to science, sustainable development and the capability of low income countries to take on leadership in global health. Change will not be sudden – the RFI is more likely to result in a progressive improvement of equitability and fairness. The RFI will ensure that low income country institutions are not just dependent on the goodwill of high income country institutions to implement ‘responsible research conduct’ guidelines. Instead, by creating transparency, the RFI will instead begin to make space for all partners to benefit from all aspects of research systems – including social and economic spin-offs.

The framework proposed by the RFI has been found useful for all stakeholders in research. It has also been used as a ‘road map’ for institutions in low income countries to indicate how to begin the progression towards becoming a nationally and globally competitive research organisation. A completed report enables targeted support for areas identified by partners themselves. In future, the RFI is likely to incite the development of benchmarks and standards – the inevitable and desired end-result of transparency.

While the RFI is still fairly new, uptake has been positive and three reports have been published thus far, with several more currently in preparation. The RFI has also already been promoted as a regional instrument to encourage best research collaboration practice between the Community of Portuguese Language Countries, and is being considered by other national, regional and funder groups. The RFI is unique in that it is NOT a new guideline – it is rather a reporting tool to create transparency and global learning in a key component of global health that has been taken for granted rather than developed – research partnerships. Through this, the RFI can make a major contribution to developing research system capacity in low income countries as integral part of doing research – it will make comprehensive research capacity building ‘routine’.

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